Healthcare Provider Details

I. General information

NPI: 1932826831
Provider Name (Legal Business Name): A PLACE OF LOVE SENIOR LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 N PALM AVE
HEMET CA
92543-1896
US

IV. Provider business mailing address

PO BOX 838
BEAUMONT CA
92223-0838
US

V. Phone/Fax

Practice location:
  • Phone: 310-592-5338
  • Fax: 844-970-1027
Mailing address:
  • Phone: 310-592-5338
  • Fax: 844-970-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: FLORENCE A MOJICA
Title or Position: LICENSEE
Credential: ADMINISTRATOR
Phone: 310-592-5338